ABSTRACT
Phyllodes tumor of the breast is an uncommonly encountered disease. The tumor presenting as fungating breast mass or 'ruptured' breast is an even more rare presentation of an unusual disease. This report documents the case of a 60-year-old female with delayed presentation of a large exophytic mass of the left breast. Biopsy of this lesion was non-diagnostic, so excision via left total mastectomy was performed. The final pathology was consistent with malignant phyllodes tumor. This report highlights the features of a rare breast cancer, the challenges in obtaining a definitive diagnosis, and the treatment of this disease, in an effort to provide clinicians with an example of the management of such a peculiar entity.
ABSTRACT
BACKGROUND: Arteriovenous fistula are created less frequently in obese individuals, and fewer of these access procedures become functional. The authors review their experience with the excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients. METHODS: Consecutive vascular access patients undergoing lipectomies for difficult access cannulation due to vein depth were reviewed. Cephalic vein depth was measured by ultrasound at 3 sites before lipectomy and again before the first cannulation. RESULTS: Thirty patients were reviewed, with a mean body mass index of 40.2 kg/m² (range, 28-57.7 kg/m²). The mean age was 52 years. Seventeen patients were women, and 19 had diabetes. The mean preoperative vein depth of 15.8 mm (range, 6-30 mm) was reduced to 4.1 mm (range, 3-8 mm) (P ≤ .01). All fistulas were functional, and only 1 failed during a follow-up period of 2.2 to 53.2 months. CONCLUSIONS: Lipectomy offers a relatively simple and successful method of extending direct autogenous vascular access to obese individuals.
